This report presents data collected
through the HIV
Testing Survey, conducted during 2002 in the states of
Florida, Illinois, Michigan, New Jersey, and Washington
and the cities of Los Angeles (California), New York City
(New York), Philadelphia (Pennsylvania), Houston (Texas),
and Milwaukee (Wisconsin). Men who have sex
with men (MSM) were recruited at gay bars, high-risk
heterosexuals (HRHs) were recruited at sexually transmitted
disease (STD) clinics, and injection drug users
(IDUs) were recruited through street outreach or at needle
exchange programs (NEPs). For each state, the largest
city and other key metropolitan areas were included.
For each venue type (bar, clinic, street/NEP), specific
sites were identified through formative research, which
included review of reports, such as local HIV/AIDS surveillance
reports (“secondary data review”), key informant
interviews, and observations at some of the
potential interview sites. Site selection by project staff
was based on the feasibility of conducting interviews at
each of the locations and on criteria for obtaining a diverse
sample of each risk group.
Persons at the venues were eligible to participate in
HITS if they were at least 18 years of age, had been a
resident of the state for at least 6 months, and gave informed
consent. Further details of selection and sampling
processes within venues have been described
elsewhere [1]. After eligibility was assessed and informed
consent obtained, participants were administered
a face-to-face interview by trained study
personnel. No personal identifiers were collected. This
study was reviewed by institutional review boards at
CDC and in participating areas. For each project area,
the intended sample size was 100 each of MSM, HRHs,
and IDUs. In addition, sites attempted to recruit approximately
equal numbers of male and female heterosexual
adults from STD clinics; there were no requirements for
gender distribution of IDUs. Of persons approached and
determined to be eligible, 3127 (83%) completed an interview:
1185 (86%) MSM, 1140 (91%) HRHs, and 802
(72%) IDUs. Of the total number of interviews, 2 were
missing age, 21 (1%) were missing residence information,
and 5 were missing sex: all 28 were excluded from
analysis.
Behaviors reported during the survey were used as
selection criteria for analysis. During the 12 months before
interview, MSM must have had sex with a man,
HRHs must have been sexually active only with members
of the opposite sex, and IDUs must have injected
drugs. Excluded from analysis were 602 (15%) persons
who completed an interview but did not report the behaviors
used as selection criteria. Of MSM interviewed in bars, 186 (13%) had not had sex with a man during the
past year. Of the HRHs interviewed in STD clinics, 104
(8%) reported that they had not had heterosexual sex or
that they had sex with a same-sex partner. Of the IDUs
recruited on the street or at NEPs, 312 (25%) reported
that they had not injected drugs during the past year.
For this report, we used several additional criteria for
exclusion from analysis. Although 20 transgender persons
were interviewed, they were excluded from analysis
because they were not consistently asked the
questions about sexual risk behavior. All persons who
reported being HIV infected were excluded from analysis
(n = 161, 5%), as were those without data on HIV testing
(n = 23, 1%) and those who never received their HIV test
results (n = 111, 4%). Because of a lack of appropriate
interviewers, Site C did not conduct the component for
IDUs. Site D was unable to collect data from an adequate
number of IDUs for the purposes of this report.
As all participants
were administered the same questionnaire, information about risk
behaviors other than those pertaining to the population recruited
(e.g., sex with men among male IDUs, injection drug use among
MSM and HRHs) are available. However, we present
risk behavior data by venue because we used venue-based
sampling as a means of reaching persons who
engaged in a specific high-risk behavior (e.g., injection
drug use only for persons recruited at street/NEP venues).
The findings in this report are subject to several limitations.
Data stratification in some instances may produce
numbers in each category that are too small for
reliable inferences. The study was not population based
but was designed to enroll equal proportions of each of
3 groups recruited from specific venues; thus, it may not
represent all at-risk populations or their distribution in the
general population. Findings from the states or cities in
this study may not be generalizable to all other states or
cities. Because the survey was administered by an interviewer,
some respondents may not have reported their
behavior accurately. For example, some respondents
may not have reported a less socially desirable behavior
in which they were engaging (e.g., sharing needles) or
may have reported a more socially desirable behavior
that they did not engage in (e.g., using a condom during
intercourse).
Reference
- Hecht FM, Chesney M, Lehman JS, et al. Does HIV
reporting by name deter testing? AIDS
2000;14:1801-1808.
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